Leading Off: Putting the new pain management guidelines into practice

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Nov 01, 2007


Robin Downing, DVM, a diplomate of the American Academy of Pain Management, is the past-president of the International Veterinary Academy of Pain Management and the hospital director of the Windsor Veterinary Clinic, Windsor, Colo. She is also a member of the Veterinary Medicine Practitioner Advisory Board.
You and your clients know that pain hurts. Clients want you to help them do the right things for their pets,1 and they expect you and your healthcare team to make pain management recommendations. Luckily, the American Animal Hospital Association (AAHA) and the American Association of Feline Practitioners (AAFP) have just put together new guidelines for pain management, which cover types of pain, recognition and assessment, and intervention (visit http://www.aahanet.org/ to view the guidelines).

GOOD MEDICINE

Pain management is good medicine. Uncontrolled or poorly controlled pain is pathologic and carries with it serious medical consequences. In human medicine, pain is considered the fifth vital sign and must be evaluated in every patient assessment. The consequences of untreated pain include decreased sleep, chronic fatigue, increased circulating cortisol concentrations, delayed healing, decreased or loss of normal behaviors, decreased activities of daily living, and increased suffering. The American Veterinary Medical Association (AVMA) states that pain management is consistent with the veterinarian's oath.

GOOD BUSINESS

Managing pain is also good business. Practicing good pain management demonstrates increased compassion for patients and clients. Increased compassion builds relationships with clients and bonds those clients to the practice. This commitment to doing more for our patients leads to increased client visits and increased revenues.

Even a conservative example can demonstrate the fiscal benefits of perioperative pain management. If a practice performs 750 surgeries a year and the veterinarian gives each patient an injectable postoperative analgesic for $15 and sends several doses of oral pain medication home for $40, the simple decision to provide greater comfort to patients in pain provides an additional $30,000 of annual gross revenue for the practice.

In addition, when every member of the veterinary healthcare team is involved in recognizing and treating pain, there is increased job satisfaction. Increased job satisfaction leads to decreased staff turnover, saving businesses money. Relieving patients' pain helps everyone feel good about the jobs they do.

IMPLEMENTING THE GUIDELINES

These five tips will help you put the AAHA/AAFP Pain Management Guidelines for Dogs & Cats into practice.

1. Adopt a pain scoring system for the practice team to use.

There is not one right answer in choosing a pain scoring system, so choose a system that the entire team will use. If you choose a 0-to-10-pain scale, spend time at team meetings introducing the scale. Demonstrate how to touch and manipulate patients to look for pain. Talk through and explain your pain assessment in the examination room for the benefit of both the client and the team member.

2. Create and deliver pain management protocols for every surgical patient.

All pain is not created equal. A pain management protocol is a template to adjust to meet each patient's needs. For example, the pain management protocol for a superficial laceration should differ from that for an ovariohysterectomy and from the protocol for a tibial plateau leveling osteotomy. James Giordano, PhD, a pain practitioner for people told me that "pain management is an ongoing clinical experiment with an 'n' of one."

Use the available resources such as the new pain management guidelines when building your pain management protocols. Excellent texts include the Handbook of Veterinary Pain Management by Drs. James S. Gaynor and William W. Muir and Pain Management for the Small Animal Practitioner by Drs. William J. Tranquilli, Kurt A. Grimm, and Leigh A. Lamont. Internet resources include the Web sites for the Veterinary Anesthesia & Analgesia Support Group ( http://www.vasg.org/) and the International Veterinary Academy of Pain Management ( http://www.ivapm.org/).